1. Field of the Invention
The present invention is directed to a method and apparatus for minimizing the cost of post-treatment follow-up and diagnostic tests and, more specifically, optimizing the surveillance schedule of follow-up diagnostic tests for cancer.
2. Description of Related Art
Many medical procedures require post-treatment monitoring of the patient's condition. The purpose of this follow-up monitoring, also known as “surveillance”, is to detect relapses early enough to allow treatment to resume. In cancer patients, post-surgery surveillance can also be an alternative to radiation therapy and chemotherapy in good-risk patients. Since only about 20% of good-risk patients experience a relapse, surveillance allows 80% of patients to avoid the costs and negative side effects associated with radiation therapy and chemotherapy. Surveillance typically involves a series of regular checkups and diagnostic tests. The diagnostic tests, which can include blood tests, X-rays, CT scans, PET scans and MRIs, can be expensive.
Unfortunately, the surveillance schedule is often ad hoc. For example, the typical surveillance schedule for testicular cancer involves follow-ups every two (2) months during the first (1st) year after treatment, every four (4) months during the second (2nd) year, every six (6) months during the third (3rd) through fifth (5th) years, and once a year thereafter. Although this schedule recognizes that most recurrences occur within five (5) years of treatment, and that recurrences are more likely to occur earlier than later, it fails to consider that the risk of relapse drops after each successful diagnostic test and that the risk of relapse decreases within each year. The number of follow-up appointments is also not optimally coordinated with the annual relapse risk.
Similarly, medical professionals recommend that a variety of diagnostic tests be performed on an annual basis after the patient reaches a certain age, as opposed to a schedule that takes age-based incidence rates and probabilities into account. These include mammograms, pap smears, colonoscopy, and prostate tests.
Current methodology for evaluating the tradeoffs between costs and benefits considers only the overall costs, such as the cost per quality of life year saved (QALY). The potential savings from micromanagement of the surveillance schedule is not currently considered.
It is, therefore, desirable to overcome the above problems and others by providing a method for optimizing the surveillance schedule of follow-up diagnostic tests. A more customized surveillance schedule would save significant costs by reducing the number of unnecessary diagnostic tests, while focusing the expenditures where they are most likely to detect disease. This would yield a similar effectiveness at detecting disease but at lower cost. Reducing the number of diagnostic tests will also improve patient compliance with the surveillance schedule, potentially increasing detection rates further. Alternately, the effectiveness could be improved while maintaining the same number of tests and the same cost.